AIDSWEEKLY Plus, Monday, 3 February 1997
Daniel J. DeNoon, Senior Editor
Potent drugs given soon after infection completely change the course of HIV disease.
There are indications that patients treated within 90 days of infection may clear the virus completely. Whether this is actually possible is the subject of intense investigation.
The findings were reported by Martin Markowitz of the Aaron Diamond AIDS Research Center at the Fourth Conference on Retroviruses and Opportunistic Infections, held January 22-26 in Washington, D.C.
"Aggressive treatment dramatically alters the natural history of HIV infection both virologically and immunologically," Markowitz and colleagues wrote in their presentation abstract. "The issue of discontinuation of therapy awaits final analysis."
Markowitz et al. treated 24 subjects who had been infected with HIV within the past 90 days. The median time from onset of acute symptoms to treatment was 55 days.
The patients received a potent protease inhibitor - either Abbott's ritonavir or Merck's indinavir - in combination with zidovudine (AZT) and lamivudine (3TC).
After 10 to 16 weeks of therapy, five of the 12 patients receiving ritonavir dropped out: two due to adverse events, two due to non-compliance, and one due to an allergic reaction.
After four to nine months of therapy, one of the 12 patients receiving indinavir was lost to follow-up.
For all compliant subjects, within months of beginning treatment, quantitative culture studies showed that infectious virus fell to below 0.1 50% tissue culture infectious doses (TCID[50]) per 10(6) peripheral blood mononuclear cells (PBMC).
Preliminary analysis of lymphoid tissues and semen collected from some of the subjects showed no signs of HIV.
A final step in the study will be to discontinue the study medications to see whether their HIV infection has been cleared. This will be done only with the patients' consent, and such patients would be monitored intensively for signs of viral rebound. - by Daniel J. DeNoon, Senior Editor
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